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Tan X, Zhang Y, Zhou J, Chen W, Zhou H. Construction and validation of a nomogram model to predict the poor prognosis in patients with pulmonary cryptococcosis. PeerJ 2024; 12:e17030. [PMID: 38487258 PMCID: PMC10939030 DOI: 10.7717/peerj.17030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
Background Patients with poor prognosis of pulmonary cryptococcosis (PC) are prone to other complications such as meningeal infection, recurrence or even death. Therefore, this study aims to analyze the influencing factors in the poor prognosis of patients with PC, so as to build a predictive nomograph model of poor prognosis of PC, and verify the predictive performance of the model. Methods This retrospective study included 410 patients (78.1%) with improved prognosis of PC and 115 patients (21.9%) with poor prognosis of PC. The 525 patients with PC were randomly divided into the training set and validation set according to the ratio of 7:3. The Least Absolute Shrinkage and Selection Operator (LASSO) algorithm was used to screen the demographic information, including clinical characteristics, laboratory test indicators, comorbidity and treatment methods of patients, and other independent factors that affect the prognosis of PC. These factors were included in the multivariable logistic regression model to build a predictive nomograph. The receiver operating characteristic curve (ROC), calibration curve and decision curve analysis (DCA) were used to verify the accuracy and application value of the model. Results It was finally confirmed that psychological symptoms, cytotoxic drugs, white blood cell count, hematocrit, platelet count, CRP, PCT, albumin, and CD4/CD8 were independent predictors of poor prognosis of PC patients. The area under the curve (AUC) of the predictive model for poor prognosis in the training set and validation set were 0.851 (95% CI: 0.818-0.881) and 0.949, respectively. At the same time, calibration curve and DCA results confirmed the excellent performance of the nomogram in predicting poor prognosis of PC. Conclusion The nomograph model for predicting the poor prognosis of PC constructed in this study has good prediction ability, which is helpful for improving the prognosis of PC and further optimizing the clinical management strategy.
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Affiliation(s)
- Xiaoli Tan
- Department of Respiratory, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Yingqing Zhang
- Department of Respiratory, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jianying Zhou
- Department of Respiratory, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenyu Chen
- Department of Respiratory, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Hua Zhou
- Department of Respiratory, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Wang X, Li S, Zhu M, Qiu Y, Hui Y, Li Y, Zhan Y, Wang Y, Ye F, Li Z. Pulmonary cryptococcosis complicated with pulmonary aspergillosis: a series of studies and a literature review. BMC Infect Dis 2024; 24:92. [PMID: 38229026 DOI: 10.1186/s12879-024-09014-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/11/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND/OBJECTIVE With the development of society, pulmonary fungal diseases, represented by pulmonary aspergillosis and pulmonary cryptococcosis, have become increasingly common. However, there is a lack of clear understanding regarding coinfection by these two types of fungi in immunocompetent individuals. METHODS A retrospective study from 2014 to 2022 and a systematic literature review of original articles published in English were performed. Patients with pulmonary cryptococcosis complicated with pulmonary aspergillosis including 5 in the retrospective study and 6 in the systematic literature review. RESULT The diagnosis of concurrent pulmonary cryptococcosis and pulmonary aspergillosis in patients was confirmed through repeated biopsies or surgical resection. Pulmonary cryptococcosis is often diagnosed initially (6/11, 55%), while the diagnosis of pulmonary aspergillosis is established when the lesions become fixed or enlarged during treatment. Transbronchial lung biopsy (3/11, 27%), thoracoscopic lung biopsy (2/11, 18%), and percutaneous aspiration biopsy of the lung (1/11, 9%) were the main methods to confirm concurrent infection. Most patients were treated with voriconazole, resulting in a cure for the coinfection (6/11, 55%). CONCLUSION Pulmonary cryptococcosis complicated with pulmonary Aspergillus is an easily neglected mixed fungal infection. During the treatment of lesion enlargement in clinical cryptococcus, we need to watch out for Aspergillus infection.
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Affiliation(s)
- Xidong Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China
| | - Shaoqiang Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China
| | - Mangui Zhu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China
- Shunde Hospital Affiliated to Guangzhou University of Chinese Medicine, FoShan, 528000, China
| | - Ye Qiu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China
| | - Yilei Hui
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China
| | - Yongming Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China
| | - Yangqing Zhan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China
| | - Yan Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China
| | - Feng Ye
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China.
| | - Zhengtu Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China.
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Zhang F, Zhou Y, Tang X, Li M. Identification of risk factors for disseminated cryptococcosis in non-hiv patients: a retrospective analysis. Eur J Med Res 2023; 28:612. [PMID: 38115055 PMCID: PMC10731787 DOI: 10.1186/s40001-023-01592-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the potential risk factors associated with disseminated cryptococcosis in HIV-negative individuals. METHODS A total of 106 HIV-negative patients with cryptococcal disease were enrolled. The observation group consisted of patients with disseminated cryptococcosis (DC), whereas the control groups included patients with pulmonary cryptococcosis (PC) and cryptococcal meningitis (CM). Univariate and multivariate logistic regression algorithms were used to explore the significant clinical and laboratory characteristics that affect the progression of cryptococcal infections. Finally, receiver operating characteristics (ROC) curves are applied to assess the diagnostic value of identified risk factors.LE: Kindly check the edit made in the title.I agree RESULTS: Of the 106 patients, 57 were diagnosed with pulmonary cryptococcosis, 22 with cryptococcal meningitis, and 27 with disseminated cryptococcosis. The logistic regression equation included five variables: diabetes, decompensated liver cirrhosis, long-term use of immunosuppressive agents, decreased serum albumin level, and elevated plasma cytokine IL-10 level. The ROC curves showed that albumin (AUC > 0.7), IL-10 (AUC > 0.7) and decompensated liver cirrhosis (AUC > 0.6) have relatively high diagnostic capacity in predicting the progression of Cryptococcus. CONCLUSION This study identified elevated IL-10 levels as an independent risk factor for developing disseminated cryptococcosis in the control groups. Furthermore, decompensated liver cirrhosis and decreased serum albumin independently affected the progression of cryptococcosis in the CM and PC groups, respectively.
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Affiliation(s)
- Fan Zhang
- School of Medicine, Shaoxing University, Shaoxing, 312000, Zhejiang, People's Republic of China
| | - Yiqing Zhou
- Department of Infectious Disease, Shaoxing People's Hospital, 568 Zhongxing Road, Shaoxing, 312000, China
| | - Xiaoqi Tang
- School of Medicine, Shaoxing University, Shaoxing, 312000, Zhejiang, People's Republic of China
| | - Minghui Li
- Department of Infectious Disease, Shaoxing People's Hospital, 568 Zhongxing Road, Shaoxing, 312000, China.
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Yang J, Chen L, Qiu F, Liu Y, Hu L. Performance of Cryptococcal Antigen Lateral Flow Assay in Bronchoalveolar Lavage Fluid in HIV-Negative Patients. Ann Clin Lab Sci 2023; 53:765-770. [PMID: 37945009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
OBJECTIVE We presented the performance of cryptococcal antigen lateral flow assay test using bronchoalveolar lavage fluid (BALF) samples in the HIV-negative Chinese population. METHODS From January 2019 to June 2022, cryptococcal antigen was detected in both serum and BALF samples from 113 patients with suspected pulmonary cryptococcosis. RESULTS 49 patients were finally diagnosed with pulmonary cryptococcosis. The sensitivity of cryptococcal antigen lateral flow assay test in serum and BALF specimens from confirmed cases was 90.0% and 96.0%, respectively, and the specificity was 87.3% and 95.5%, respectively. When the diameter of the lung lesion was less than 15 mm, the antigen positivity rate of BALF was higher than that of serum. Moreover, the result of the cryptococcal antigen test was associated with the lymphocytes count of BALF. CONCLUSION Our data demonstrate that cryptococcal antigen Lateral Flow Assay for BALF specimens might contribute to the early diagnosis of pulmonary cryptococcosis.
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Affiliation(s)
- Jing Yang
- Department of Respiratory and Critical Care Medicine, Ningbo, Zhejiang, China
| | - Lei Chen
- Department of Respiratory and Critical Care Medicine, Ningbo, Zhejiang, China
| | - Feng Qiu
- Department of Respiratory and Critical Care Medicine, Ningbo, Zhejiang, China
| | - Yanqing Liu
- Departments of Laboratory Medicine, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Liqing Hu
- Departments of Laboratory Medicine, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
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Shi J, Chen J, Hu L, Ma AHY, Hu H, Wang C, Huang J, Song Q, Qian G. Retrospective analysis of pulmonary cryptococcosis and extrapulmonary cryptococcosis in a chinese tertiary hospital. BMC Pulm Med 2023; 23:277. [PMID: 37501136 PMCID: PMC10375642 DOI: 10.1186/s12890-023-02578-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 07/21/2023] [Indexed: 07/29/2023] Open
Abstract
Cryptococcosis is an invasive fungal disease with increased morbidity in China over the past two decades. Cryptococci can infect immunocompromised hosts as well as immunocompetent ones. In this study, we reviewed data of 71 inpatients with cryptococcosis at Ningbo First Hospital from May 2010 to May 2020 and compared the clinical profiles of pulmonary cryptococcosis (PC) and extrapulmonary cryptococcosis (EPC). Of 71 patients (38 males, 33 females), 70 were non-HIV. The annual inpatient population increased dramatically, especially in the PC group. PC was confirmed in 77.46% (55/71) of cases by pathology. The rest were EPC including intracranial infection (15.49%, 11/71) and cryptococcemia (7.04%, 5/71). Compared with PC, a larger proportion of EPC patients were found to have immunocompromised conditions judged by predisposing factors (p < 0.01), or detectable humoral or cellular immunodeficiency. Fever and headache were more common in EPC patients (p < 0.001). Patients with EPC had lower serum sodium level (p = 0.041), lower monocyte counts (p = 0.025) and higher C-reactive protein (p = 0.012). In our study, the sensitivity of cryptococcus antigen detection for EPC was 100% regardless of sample type, while serum lateral flow assay (LFA) tested negative in 25% (5/20) of PC. Immunocompromised hosts are more likely to suffer from EPC than PC.
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Affiliation(s)
- Jiejun Shi
- Department of Infectious Diseases, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang Province, China.
| | - Jianhua Chen
- Department of Radiology, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang Province, China
| | - Liqing Hu
- Department of Clinical Laboratory, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Ada Hoi Yan Ma
- Nottingham University Business School, University of Nottingham Ningbo China, Ningbo, Zhejiang Province, China
| | - Haoxuan Hu
- Department of Internal Medicine, Fenghua District Hospital, Ningbo, Zhejiang Province, China
| | - Chuwen Wang
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Jiajia Huang
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Qifa Song
- Medical Data Research Center, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang Province, China
| | - Guoqing Qian
- Department of Infectious Diseases, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang Province, China
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Yan Y, Wu Y, Wang Q, Zhu X, Li H, Jiang H. Lesion size as a prognostic factor in the antifungal treatment of pulmonary cryptococcosis: a retrospective study with chest CT pictorial review of 2-year follow up. BMC Infect Dis 2023; 23:153. [PMID: 36918805 PMCID: PMC10012437 DOI: 10.1186/s12879-023-08131-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 03/02/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Pulmonary cryptococcosis (PC) is a fungal infection that can have a variable prognosis depending on several factors. The objective of this study was to analyse the characteristics of pulmonary lesions and identify prognostic factors in patients with PC who were human immunodeficiency virus (HIV) -negative and underwent antifungal treatment. METHODS The study enrolled patients diagnosed with PC who were negative for HIV. Symptoms, CT characteristics of pulmonary lesions, serum cryptococcal capsular antigen (CrAg) titre, underlying diseases, and duration of antifungal treatment were evaluated over a 2-year follow-up. RESULTS A total of 63 patients (40 men and 23 women) with a mean age of 50.4 years were included. Half of the patients (50.8%) were asymptomatic, and the most common symptoms were cough (44.4%), expectoration (27.0%), and fever (17.5%). Pulmonary lesions were mainly present in the peripheral and lower lobes of the lung, with 35 cases classified as nodular-type lesions and 28 cases classified as mass-type lesions. At the first, third, sixth, 12th, and 24th-month follow-ups, the median proportion of residual pulmonary lesions were 59.6%, 29.9%, 12.2%, 9.6%, and 0.0%, respectively. During antifungal treatment, the lesions of 33 patients achieved complete response, while the remaining 30 patients did not. Compared with the non-CR group, the CR group had a lower baseline serum CrAg titre (median, 1:20 vs 1:80, P < 0.01), smaller pulmonary lesion size (median area, 1.6 cm2 vs 6.3 cm2, P < 0.01), lower Hounsfield-units (HU) radiodensity (median, - 60.0 HU vs - 28.5 HU, P < 0.05), more nodular-type lesions (72.7% vs 36.7%, P < 0.01), and fewer air-bronchogram signs (18.2% vs 43.3%, P < 0.05). Multivariate logistic regression analysis showed that a larger lesion size on chest CT scans was associated with a lower likelihood of achieving complete response [OR: 0.89; 95% CI (0.81-0.97); P < 0.05]. CONCLUSIONS PC was more commonly observed in HIV-negative men, and chest CT scans mostly revealed nodular-type lesions. After antifungal treatment, patients with smaller lesions had a better prognosis.
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Affiliation(s)
- Yu Yan
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yuxiao Wu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Qin Wang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Xiaodan Zhu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Huayin Li
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Hongni Jiang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. .,Department of Pulmonary Medicine, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian, 361015, China.
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Fang YF, Cao XH, Yao LY, Cao Q. Pulmonary cryptococcosis after immunomodulator treatment in patients with Crohn’s disease: Three case reports. World J Gastroenterol 2023; 29:758-765. [PMID: 36742174 PMCID: PMC9896616 DOI: 10.3748/wjg.v29.i4.758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Corticosteroids and anti-tumor necrosis factor α mAbs are widely used to treat Crohn's disease (CD). However, one disadvantage of this treatment is impairment of normal immune function, leading to an increased risk of infection. Cryptococcus infection is an opportunistic infection that occurs mainly in immunocompromised patients and poses a significant diagnostic challenge in patients with CD.
CASE SUMMARY Here, we report three cases of pulmonary cryptococcosis in patients with CD after receiving immunomodulatory treatment. The patients presented with no or mild respiratory symptoms. Chest computed tomography scans revealed pulmonary nodules in the unilateral or bilateral lobes. Diagnoses were made using pathological examination and metagenomic sequencing. The patients were treated with fluconazole 400 mg once daily for 1 to 6 mo, and symptoms were resolved. Literature searches were conducted in PubMed, Web of Science, and Embase to retrieve previously reported cases and summarize patient characteristics.
CONCLUSION The incidence of cryptococcus infection has increased along with immunomodulator use. Clinical vigilance is required for early identification and standardized treatment.
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Affiliation(s)
- Yan-Fei Fang
- Department of Gastroenterology, Inflammatory Bowel Disease Center, Sir Run Shaw Hospital, College of Medicine Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Xiang-Han Cao
- Department of Gastroenterology, Inflammatory Bowel Disease Center, Sir Run Shaw Hospital, College of Medicine Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Ling-Ya Yao
- Department of Gastroenterology, Inflammatory Bowel Disease Center, Sir Run Shaw Hospital, College of Medicine Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Qian Cao
- Department of Gastroenterology, Inflammatory Bowel Disease Center, Sir Run Shaw Hospital, College of Medicine Zhejiang University, Hangzhou 310016, Zhejiang Province, China
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Qin Z, Zou Y, Huang Z, Yu N, Deng Z, Chen Z, Wang Y. Metagenomic next-generation sequencing contributes to the diagnosis of mixed pulmonary infection: a case report. Ann Clin Microbiol Antimicrob 2022; 21:52. [PMID: 36434704 PMCID: PMC9701064 DOI: 10.1186/s12941-022-00545-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Pulmonary cryptococcosis (PC) and mixed pulmonary infection are difficult to be diagnosed due to the non-specificity and their overlapping clinical manifestations. In terms of the clinical diagnosis of PC and mixed pulmonary infection, conventional tests have limitations such as a long detection period, a limited range of pathogens, and low sensitivity. Metagenomics next-generation sequencing (mNGS) is a nascent and powerful method that can detect pathogens without culture, to diagnose known and unexplained infections in reduced time. CASE PRESENTATION A 43-year-old female was admitted to the hospital after suffering from a cough for one month. At the time of admission, a contrast-enhanced chest CT revealed multiple nodules and plaques in her right lung, as well as the formation of cavities. The blood routine assays showed evidently increased white blood cell count (mainly neutrophils), CRP, and ESR, which suggested she was in the infection phase. The serum CrAg-LFA test showed a positive result. Initially, she was diagnosed with an unexplained pulmonary infection. Bronchoalveolar lavage fluid (BALF) samples were collected for microbial culture, immunological tests and the mNGS. Microbial culture and immunological tests were all negative, while mNGS detected Corynebacterium striatum, Pseudomonas aeruginosa, Streptococcus pneumoniae, and Cryptococcus neoformans. The diagnosis was revised to PC and bacterial pneumonia. Lung infection lesions were healed after she received targeted anti-infection therapy with mezlocillin and fluconazole. In a follow-up after 2 months, the patient's symptoms vanished. CONCLUSIONS Here, we demonstrated that mNGS was capable of accurately distinguishing Cryptococcus from M. tuberculosis in pulmonary infection, and notably mNGS was capable of swiftly and precisely detecting pathogens in mixed bacterial and fungal pulmonary infection. Furthermore, the results of mNGS also have the potential to adjust anti-infective therapies.
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Affiliation(s)
- Ziqian Qin
- Clinical Genome Center, Guangxi Kingmed Diagnostics, Nanning, 530007 Guangxi China
| | - Yiwu Zou
- grid.256607.00000 0004 1798 2653The First People’s Hospital of Qinzhou, The Tenth Affiliated Hospital of Guangxi Medical University, Qinzhou, 535000 Guangxi China
| | - Zehe Huang
- grid.256607.00000 0004 1798 2653The First People’s Hospital of Qinzhou, The Tenth Affiliated Hospital of Guangxi Medical University, Qinzhou, 535000 Guangxi China
| | - Ning Yu
- Clinical Genome Center, Guangxi Kingmed Diagnostics, Nanning, 530007 Guangxi China
| | - Zhenfeng Deng
- Clinical Genome Center, Guangxi Kingmed Diagnostics, Nanning, 530007 Guangxi China
| | - Zhencheng Chen
- grid.440723.60000 0001 0807 124XGuilin University of Electronic Technology, Guilin, 541004 Guangxi China
| | - Yuanli Wang
- grid.256607.00000 0004 1798 2653The First People’s Hospital of Qinzhou, The Tenth Affiliated Hospital of Guangxi Medical University, Qinzhou, 535000 Guangxi China ,grid.440723.60000 0001 0807 124XGuilin University of Electronic Technology, Guilin, 541004 Guangxi China
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Chang CY, Mohd Shah SH, Lio JY, Bahari N, Radhakrishnan AP. Cryptococcus gattii meningitis complicated by immune reconstitution inflammatory syndrome in an apparent immunocompetent host in Malaysia. Med Mycol Case Rep 2022; 35:1-4. [PMID: 34984166 PMCID: PMC8693149 DOI: 10.1016/j.mmcr.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/26/2021] [Accepted: 12/10/2021] [Indexed: 11/22/2022] Open
Abstract
Cryptococcosis is a systemic fungal infection caused by Cryptococcus neoformans or Cryptococcus gattii. Cryptococcus causes a wide range of diseases, ranging from asymptomatic pulmonary lesions to disseminated disease involving the central nervous system, particularly meningoencephalitis. C. gattii infection has rarely been reported in Malaysia. We present a case of C. gattii meningitis with pulmonary cryptococcosis complicated by immune reconstitution inflammatory syndrome in an apparently immunocompetent person with no prior travel history. Cryptococcosis is a fungal infection causing significant morbidity and mortality. Cryptococcus gattii can present with meningitis and pulmonary cryptococcosis. CSF examination is the cornerstone of diagnosis in cryptococcal meningitis. IRIS is a rare complication of C. gattii infection that can be treated with steroids.
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Affiliation(s)
- Chee Yik Chang
- Infectious Disease Unit, Medical Department, Hospital Selayang, 68100, Batu Caves, Selangor, Malaysia
- Corresponding author.
| | - Syarul Hafiz Mohd Shah
- Infectious Disease Unit, Medical Department, Hospital Selayang, 68100, Batu Caves, Selangor, Malaysia
| | - Jia Yin Lio
- Infectious Disease Unit, Medical Department, Hospital Selayang, 68100, Batu Caves, Selangor, Malaysia
| | - Norazlah Bahari
- Microbiology Unit, Pathology Department, Hospital Selayang, 68100, Batu Caves, Selangor, Malaysia
| | - Anuradha P. Radhakrishnan
- Infectious Disease Unit, Medical Department, Hospital Selayang, 68100, Batu Caves, Selangor, Malaysia
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Hsiao PJ, Cheng H, Kao YH, Wang YH, Chiu CC, Chiang WF, Kuo CC, Chuu CP, Wu KA. Comparison of laboratory diagnosis, clinical manifestation, and management of pulmonary cryptococcosis: Report of the clinical scenario and literature review. Clin Chim Acta 2022; 524:78-83. [PMID: 34843703 DOI: 10.1016/j.cca.2021.11.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/04/2021] [Accepted: 11/17/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pulmonary cryptococcosis is an opportunistic aggressive mycosis in immunocompromised patients, but it can be increasingly seen in immunocompetent patients. It is still challenging to make a rapid and accurate diagnosis due to the various clinical manifestations and limitations in the diagnostic tools. METHOD A 54-year-old man presented with intermittent productive cough and fever for 1 week. A chest X-ray demonstrated multiple consolidations in both lungs. Blood biochemistry indicated elevated immunoglobulin G levels. Including sputum cultures, polymerase chain reaction (PCR) tests for severe acute respiratory syndrome coronavirus 2, influenza A and B virus were all negative. Computed tomography of the chest showed ground-glass opacities with a nodular pattern. The serum cryptococcal antigen test was positive; however, the cerebral spinal fluid was negative. The diagnosis of pulmonary cryptococcal infection was made. An initial bronchoscopy was performed unsuccessfully and the patient received intravenous fluconazole therapy for 2 weeks. Due to poor improvement of clinical condition, he then underwent a surgical lung biopsy. The pathology revealed several encapsulated yeast cells, diffuse pulmonary interstitial fibrosis, noncaseating granulomas surrounded by T lymphocytes and multinucleated giant cells with intracellular inclusions, confirming pulmonary yeast infection associated with hypersensitivity pneumonitis. Ultimately, fungal cultures of the pathology samples revealed Cryptococcus neoformans. Subsequently antifungal therapy combined with oral steroid treatment, his general condition improved. After a total of 6 months of antifungal therapy, the patient recovered completely. CONCLUSIONS Applicable laboratory diagnosis can help facilitate the accurate and rapid diagnosis of pulmonary cryptococcosis. This report elected to provide an update on the topic of laboratory diagnosis, clinical manifestation, and management of pulmonary cryptococcosis.
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Affiliation(s)
- Po-Jen Hsiao
- Division of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan; Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Life Sciences, National Central University, Taoyuan, Taiwan.
| | - Han Cheng
- Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Yung-Hsi Kao
- Department of Life Sciences, National Central University, Taoyuan, Taiwan
| | - Yuan-Hung Wang
- Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan; Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Chiun Chiu
- Division of Infectious Disease, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan; Division of Infectious Disease and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Fang Chiang
- Division of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan; Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Chun Kuo
- Division of Metabolism and Endocrinology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Chih-Pin Chuu
- Institute of Cellular and System Medicine, National Health Research Institutes, Miaoli County, Taiwan; Graduate Program for Aging, China Medical University, Taichung, Taiwan
| | - Kuo-An Wu
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
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11
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Abstract
Pulmonary cryptococcosis is rare in immunocompetent individuals. Limited data exist regarding its occurrence in children, especially in developing countries. This case report describes an 8-year-old HIV-negative child with pulmonary cryptococcosis, previously diagnosed and treated for tuberculosis twice without improvement. Fine needle aspiration biopsy confirmed the diagnosis of pulmonary cryptococcosis and serum cryptococcal antigen test was positive. The child improved on amphotericin and fluconazole treatment. Despite the limited diagnostic capacity in many resource-constrained settings like Uganda, this case report highlights the need to investigate other causes of pneumonia in immunocompetent children that are not improving on conventional antimicrobial treatments.
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Affiliation(s)
- Irene Nakatudde
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University
| | | | - Sarah Kiguli
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University
| | - Philippa Musoke
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
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12
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张 晓, 赵 顺, 周 春. [Case Report: Three Pediatric Pulmonary Cryptococcosis Patients with Prominent Manifestation of Mediastinal Lymphadenopathy]. Sichuan Da Xue Xue Bao Yi Xue Ban 2021; 52:859-861. [PMID: 34622606 PMCID: PMC10408885 DOI: 10.12182/20210960204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Indexed: 11/23/2022]
Abstract
In this study, we report on three immunocompetent children with pulmonary cryptococcosis presenting mediastinal lymphadenopathy as the prominent manifestation. All three children were otherwise healthy previously. Two children had a history of exposure to pigeons and poultry. All three presented persistent fever accompanied by mild cough. There were no obvious positive signs in the lungs. One patient had enlarged cervical lymph nodes. All three had elevated levels of white blood cells, neutrophil count, and C-reactive protein (CRP). The levels of IgG, IgM, IgA, IgE and T cell subsets were normal in all cases, and they were all tested negative for HIV antibody. Two children were tested positive for serum cryptococcal antigen (sCRAG). The chest X-ray and pulmonary CT findings of the three patients all demonstrated marked enlargement of mediastinal lymph nodes, and one patient had nodules in the parenchyma. Surgical biopsies of mediastinal lymph nodes were performed in two children and large numbers of capsule spores were found in the histological examination. In the three cases, definitive diagnosis of pulmonary cryptococcosis were made in two patients, and clinical diagnosis was made in the third patient. Two patients were treated with fluconazole alone. The other patient whose condition was complicated with spleen infection was treated with fluconazole combined with amphotericin B for the first month, and was then given fluconazole for maintenance treatment. The overall treatment course lasted 5-9 months and all three were cured eventually. In conclusion, immunocompetent children with pulmonary cryptococcosis may present mediastinal lymphadenopathy as a prominent or isolated manifestation, which should be considered in differential diagnosis. Treatment with fluconazole alone or in combination with amphotericin B when it was necessary showed good therapeutic outcomes.
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Affiliation(s)
- 晓艳 张
- 国家儿童医学中心 首都医科大学附属北京儿童医院 呼吸二科 (北京 100045)Department Ⅱ of Respiratory Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
| | - 顺英 赵
- 国家儿童医学中心 首都医科大学附属北京儿童医院 呼吸二科 (北京 100045)Department Ⅱ of Respiratory Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
| | - 春菊 周
- 国家儿童医学中心 首都医科大学附属北京儿童医院 呼吸二科 (北京 100045)Department Ⅱ of Respiratory Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
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13
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Hu Y, Ren SY, Xiao P, Yu FL, Liu WL. The clinical and radiological characteristics of pulmonary cryptococcosis in immunocompetent and immunocompromised patients. BMC Pulm Med 2021; 21:262. [PMID: 34389002 PMCID: PMC8361630 DOI: 10.1186/s12890-021-01630-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/03/2021] [Indexed: 12/12/2022] Open
Abstract
Background We characterized the clinical features, radiographic characteristics, and response to treatment of immunocompetent and immunocompromised patients with pulmonary cryptococcosis (PC). Methods We retrospectively reviewed the medical records and radiological profiles of patients diagnosed with PC who received surgical resection between May 2015 and November 2020 in a tertiary referral center. Results A total of 21 males and 18 females were included in the study. 23 patients were immunocompetent and 20 out of the 39 were asymptomatic. Immunocompetent patients were diagnosed with PC at a younger age than immunocompromised patients (48.9 vs 57.1 years, P = 0.02). Single nodule pattern was the most frequent lesion pattern (33 out of 39, 84.6%) and right upper lobe was the most common site of location (15 out of 47, 31.9%). The majority of lesions were located peripherally (38 out of 47, 80.9%) and most lesions were 1–2 cm in diameter (30 out of 47, 63.8%). Cavitation was more likely to occur in immunocompromised patients (5 out of 11, 45.5%) than in immunocompetent patients (6 out of 36, 16.7%) (P = 0.04) and there was complete resolution of PC in all patients treated with anti-fungal therapy. Conclusions Immunocompetent patients were diagnosed with PC at a younger age than immunocompromised patients. Single nodule pattern was the most frequent lesion pattern in PC patients. Cavitation was more likely to occur in immunocompromised patients than in immunocompetent patients.
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Affiliation(s)
- Yan Hu
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, 410011, China
| | - Si-Ying Ren
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Peng Xiao
- Department of Cardiothoracic Surgery, The Third Xiangya Hospital of Central South University, Changsha, 410013, China
| | - Feng-Lei Yu
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, 410011, China
| | - Wen-Liang Liu
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, 410011, China.
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Xu L, Song X, Zhang Y, Lin N, Wang JA. Sjögren's syndrome with nervous system injury combined with pulmonary and osseous cryptococcosis: a case report. J Med Case Rep 2021; 15:325. [PMID: 34167586 PMCID: PMC8229340 DOI: 10.1186/s13256-021-02941-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 06/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sjögren's syndrome is a common autoimmune disease that can involve the nervous system, but rarely both the central and peripheral. Long-term use of high-dose corticosteroids and immunosuppressants are the main risk factors for Cryptococcus infection in patients with Sjögren's syndrome, of which pulmonary infection is the most common, while multiple bone infections are rare. CASE PRESENTATION A 46-year-old Chinese woman with a 2-year history of Sjögren's syndrome presented to our hospital with numbness of limbs, shortness of breath, and weakness. Blood immunochemistry showed that antinuclear antibody (1:640), anti-Sjögren's syndrome-A antibodies, and anti-centromere antibodies were strongly positive. Cranial magnetic resonance imaging revealed multiple demyelinating lesions in the white matter of bilateral cerebral hemispheres. Electromyography indicated serious peripheral nerve injury, especially in lower limbs. Computed tomography scan of lumbar vertebral displayed multiple high-density shadows, and the corresponding vertebrae on magnetic resonance imaging showed abnormal low signal intensity on T1 and T2 sequences. Positron emission tomography-computed tomography showed multiple lesions with high 18F-fluorodeoxyglucose uptake in lung and vertebral bodies. Both lung and bone biopsies suggested Cryptococcus infection, with the diagnosis of Sjögren's syndrome with nervous system injury combined pulmonary and osseous cryptococcosis. She took a reduced dose of prednisone about 10 mg/day, terminated mycophenolate mofetil, and began to take immunoglobulin of 0.4 g/kg/day intravenously for 5 days, fluconazole (400 mg/day) for 6 months. Within 3 weeks, her chest radiography showed a marked improvement, and 3 months later, the pulmonary lesions disappeared on her computed tomography scan. CONCLUSIONS This case exhibits an extremely rare condition of neural involvement in Sjögren's syndrome combined with pulmonary and osseous cryptococcosis. This report also highlights the crucial role of detailed clinical examination, serologic markers, and biopsy in avoiding misdiagnosis. Currently, there is no guideline for this situation; in this case, we controlled the disease successfully with antifungal drugs and adequate gamma globulin, followed by an appropriate dose of corticosteroids.
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Affiliation(s)
- Liping Xu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006 China
| | - Xinwei Song
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006 China
| | - Yan Zhang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006 China
| | - Na Lin
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006 China
| | - Ji-An Wang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006 China
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15
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Li Z, Wang M, Zeng P, Chen Z, Zhan Y, Li S, Lin Y, Cheng J, Ye F. Examination of a Chinese-made cryptococcal glucuronoxylomannan antigen test in serum and bronchoalveolar lavage fluid for diagnosing pulmonary cryptococcosis in HIV-negative patients. J Microbiol Immunol Infect 2021; 55:307-313. [PMID: 34052144 DOI: 10.1016/j.jmii.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 04/21/2021] [Accepted: 05/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND We presented the performance of a Chinese-made cryptococcal glucuronoxylomannan (GXM) antigen test using serum and bronchoalveolar lavage fluid (BALF) samples in the HIV-negative Chinese population. METHODS Between February 2017 and January 2019, HIV-negative patients with pulmonary cryptococcosis were recruited and followed-up every three months, including completion of a chest CT examination and collection of serum and BALF samples. RESULTS Here, thirty-seven confirmed and ten clinically diagnosed patients were recruited. Furthermore, samples from 174 noncryptococcosis patients that may cause false positives were also collected. The sensitivity of a lateral flow assay (LFA) for detecting cryptococcal GXM antigen in serum and BALF samples from confirmed cases was 97% and 95%, respectively, and the specificity was 98.2% and 93%, respectively, and the differences in these values between the BALF and serum samples were not significant. The serum cryptococcal GXM antigen value showed a positive correlation (r: 0.581, p < 0.001) with pulmonary lesion size, while the BALF value showed no correlation (r: 0.253, p: 0.13). The positivity rate of BALF was higher than that of serum when the diameter of the pulmonary lesion was small (diameter less than 20 mm). Moreover, the serum cryptococcal GXM antigen levels showed an overall decreasing trend with the decrease in pulmonary lesion size after antifungal therapy in patient follow-up. CONCLUSIONS The Chinese-made cryptococcal GXM antigen test has better sensitivity and specificity for diagnosing pulmonary cryptococcosis in the HIV-negative Chinese population, and it could be used to diagnose and to monitor this disease.
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Affiliation(s)
- Zhengtu Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Mingdie Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Peiying Zeng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Zhaoming Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Yangqing Zhan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Shaoqiang Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Ye Lin
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Jing Cheng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Feng Ye
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.
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16
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Abstract
Objective To analyse the clinicopathological features of isolated pulmonary cryptococcosis in human immunodeficiency virus (HIV)-negative patients. Methods This retrospective study analysed the following data from HIV-negative patients diagnosed with pulmonary cryptococcosis: demographics, underlying diseases, clinical manifestations on admission, laboratory tests, imaging data, results of histopathology, treatment options and outcomes. Sputum samples from all patients were collected and assessed for the presence of yeast or fungi. Cryptococcal antigen testing was performed for some patients. Histopathological analysis was also undertaken for some samples of lung tissue. Results The study analysed 37 patients (22 males). Thirteen (35.14%) patients were asymptomatic, 24 (64.86%) were symptomatic and 17 (45.95%) patients had no underlying disease. Out of 25 tested patients, 23 (92.00%) tested positive on the serum cryptococcal capsular polysaccharide antigen test. During 6 to 24 months of follow-up, all 37 patients that were either treated with or without antifungal therapy alone or combined with surgical resection showed complete recovery. One patient made a full recovery without any treatment. Conclusion Early identification of pulmonary cryptococcosis in HIV-negative patients and timely detection of cryptococcal antigens in serum or respiratory specimens may help to improve diagnosis, prognosis and treatment of the disease.
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Affiliation(s)
- Huan-Huan Wu
- Department of Respiratory Medicine, Dongyang Hospital Affiliated to Wenzhou Medical University, Dongyang, Zhejiang Province, China
| | - Yan-Xiao Chen
- Department of Evidence-based Medicine, Dongyang Hospital Affiliated to Wenzhou Medical University, Dongyang, Zhejiang Province, China
| | - Shuang-Yan Fang
- Department of Respiratory Medicine, Dongyang Hospital Affiliated to Wenzhou Medical University, Dongyang, Zhejiang Province, China
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17
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Yu H, Wang K, Huang D, Wen L, Zhang Y, Wang Y, Tang Y, Dong J, Liang Z. Crazy-paving patterns as rare radiological manifestations of pulmonary cryptococcosis: a case report. BMC Pulm Med 2021; 21:84. [PMID: 33711958 PMCID: PMC7952504 DOI: 10.1186/s12890-021-01450-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/01/2021] [Indexed: 02/08/2023] Open
Abstract
Background Crazy-paving patterns are rarely reported as radiological manifestations of pulmonary cryptococcosis. Case presentation Herein, we presented a very rare case of a crazy-paving pattern as a radiological manifestation of pulmonary cryptococcosis in a patient with primary ciliary dyskinesia. The diagnosis of pulmonary cryptococcosis and primary ciliary dyskinesia was ultimately confirmed by bronchoscopic biopsy, fungus culture, whole exome sequencing of blood, etc. The patient received flucytosine (PO, 5 g per day) and amphotericin B (IV, 70 mg per day) during hospitalization and sequential therapy with voriconazole (PO, 200 mg twice a day) after discharge. He recovered during follow-up. Conclusions We concluded that pulmonary cryptococcosis should be considered a possible cause of crazy-paving patterns in chest CT scans.
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Affiliation(s)
- He Yu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Kaige Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Dong Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Lu Wen
- Department of Respiratory and Critical Care Medicine, The People's Hospital of Pengzhou, Chengdu, Sichuan, China
| | - Ying Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ye Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Yongjiang Tang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Jiajia Dong
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Zongan Liang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
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18
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Chen LA, She DY, Liang ZX, Liang LL, Chen RC, Ye F, Li YP, Zhou Y, Chen XH, Fang SF, Lai GX, Hu Q, Xie BS, Yao XJ, Shi Y, Su X, He LX, Zhou JY, Zhong SC, Zhang QL, Xiong SD, Qu JM, Tong ZH, Jiang SJ, Liu J, Xu F, He B, Li ER, Yuan YD, Zhang XY, Sun TY, Liu YN. [A prospective multi-center clinical investigation of HIV-negative pulmonary cryptococcosis in China]. Zhonghua Jie He He Hu Xi Za Zhi 2021; 44:14-27. [PMID: 33412620 DOI: 10.3760/cma.j.cn112147-20200122-00034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the current status of the diagnosis and treatment of pulmonary cryptococcosis in respiratory medicine and improve the understanding of the clinical characteristics of HIV-negative pulmonary cryptococcosis in China. Methods: A prospective multi-center open cohort study was designed to screen for pulmonary cryptococcosis in the general wards and intensive care units of the Department of Respiratory Diseases in 22 hospitals. The HIV-negative patients with positive cryptococcal etiological diagnosis based on smear culture, antigen detection and histopathology were enrolled in the study. The clinical data of enrolled patients were collected and analyzed. Results: A total of 457 cases of pulmonary cryptococcosis were enrolled, among which 3.28% (15/457) were disseminated infections. The case fatality rate was 0.88% (4/457). The majority of the cases were diagnosed by histopathological examinations (74.40%, 340/457) and cryptococcus antigen detection (37.64%, 172/457). Patients with pulmonary cryptococcosis accounted for 2.04‰ (457/223 748) of the total hospitalized patients in the Department of Respiratory Diseases during the same period, and the ratio was the highest in south and east China. Meanwhile, 70.24% (321/457) of the patients had no underlying diseases, while 87.75% (401/457) were found to have immunocompetent status. Cough and expectoration were the most common clinical symptoms in patients with pulmonary cryptococcosis. However, 25.16% (115/457) of the patients had no clinical symptom or physical signs. In terms of imaging features on pulmonary CT, multiple pulmonary lesions were more common than isolated lesions, and there were more subpleural lesions than perihilar or medial lesions. Morphologically, most of the lesions were middle-sized nodules (1-5 cm) or small-sized nodules (3 mm to 1 cm). The sensitivity of serum cryptococcus antigen test was 71.99% (203/282). Moreover, antigen-positive patients differed from antigen-negative patients in terms of basic immune status, clinical symptoms, imaging features and infection types. Meanwhile, immunocompromised patients differed from immunocompetent patients in terms of clinical symptoms, physical signs, infection-related inflammation indicator levels, imaging features, serum cryptococcus antigen positive rate and prognosis. Conclusions: The majority of cases of HIV-negative pulmonary cryptococcosis in China had no underlying disease or immunocompromised status, and the overrall prognosis was favorable. However, early diagnosis of HIV-negative pulmonary cryptococcosis remains challenging due to the complicated manifestations of the disease.
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Affiliation(s)
- L A Chen
- Department of Pulmonary and Critical Care Medicine, the First Medical Center of General Hospital of Chinese People's Liberation Army, Beijing 100853, China
| | - D Y She
- Department of Pulmonary and Critical Care Medicine, the First Medical Center of General Hospital of Chinese People's Liberation Army, Beijing 100853, China
| | - Z X Liang
- Department of Pulmonary and Critical Care Medicine, the First Medical Center of General Hospital of Chinese People's Liberation Army, Beijing 100853, China
| | - L L Liang
- Department of Pulmonary and Critical Care Medicine, the First Medical Center of General Hospital of Chinese People's Liberation Army, Beijing 100853, China
| | - R C Chen
- Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - F Ye
- Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Y P Li
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000, China
| | - Y Zhou
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000, China
| | - X H Chen
- Department of Pulmonary and Critical Care Medicine, Fuzhou Pulmonary Hospital of Fujian, Fuzhou 350008, China
| | - S F Fang
- Department of Pulmonary and Critical Care Medicine, Fuzhou Pulmonary Hospital of Fujian, Fuzhou 350008, China
| | - G X Lai
- Department of Pulmonary and Critical Care Medicine, 900 Hospital of the Joint Logistics Team Support Force,Fuzhou 350025, China
| | - Q Hu
- Department of Pulmonary and Critical Care Medicine, 900 Hospital of the Joint Logistics Team Support Force,Fuzhou 350025, China
| | - B S Xie
- Department of Pulmonary and Critical Care Medicine, Fujian Provincial Hospital,Fuzhou 350001, China
| | - X J Yao
- Department of Pulmonary and Critical Care Medicine, Fujian Provincial Hospital,Fuzhou 350001, China
| | - Y Shi
- Department of Pulmonary and Critical Care Medicine, the General Hospital of Eastern Theater Command;,Nanjing 210002, China
| | - X Su
- Department of Pulmonary and Critical Care Medicine, the General Hospital of Eastern Theater Command;,Nanjing 210002, China
| | - L X He
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University,Shanghai 200032, China
| | - J Y Zhou
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - S C Zhong
- Department of Pulmonary and Critical Care Medicine, Longyan First Hospital,Longyan 364000, China
| | - Q L Zhang
- Department of Neurology Medicine, Jiangxi Chest Hospital,Nanchang 330006, China
| | - S D Xiong
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - J M Qu
- Department of Pulmonary and Critical Care Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Z H Tong
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University,Beijing 100020, China
| | - S J Jiang
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital,Jinan 250021, China
| | - J Liu
- Department of Pulmonary and Critical Care Medicine, the Second Hospital of Jilin University, Changchun 130041, China
| | - F Xu
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Nanchang University,Nanchang 330006, China
| | - B He
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital,Beijing 100191, China
| | - E R Li
- Department of Pulmonary and Critical Care Medicine, the First Hospital of China Medical University,Shenyang 110001, China
| | - Y D Yuan
- Department of Pulmonary and Critical Care Medicine, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - X Y Zhang
- Department of Pulmonary and Critical Care Medicine, Guzhou Provincial People's Hospital,Guiyang 550002, China
| | - T Y Sun
- Department of Pulmonary and Critical Care Medicine, Beijing Hospital,Beijing 100730, China
| | - Y N Liu
- Department of Pulmonary and Critical Care Medicine, the First Medical Center of General Hospital of Chinese People's Liberation Army, Beijing 100853, China
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19
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Zheng GX, Tang HJ, Huang ZP, Pan HL, Wei HY, Bai J. Clinical characteristics of pulmonary cryptococcosis coexisting with lung adenocarcinoma: Three case reports. World J Clin Cases 2020; 8:6444-6449. [PMID: 33392329 PMCID: PMC7760435 DOI: 10.12998/wjcc.v8.i24.6444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/25/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pulmonary cryptococcosis (PC) is an invasive fungal disease caused mainly by Cryptococcus (C.) neoformans or C. gattii. It may be present in immunocompetent or immunocompromised patients. The radiographic features of PC vary, and the most common computed tomography manifestation is the presence of solitary or multiple pulmonary nodules or masses distributed in the outer zone of the lung field. The appearance of nodular or mass-like PC on computed tomography scans resembles that of primary or metastatic lung cancers, and differential diagnosis is sometimes difficult. The coexistence of PC and malignant tumors is rarely observed.
CASE SUMMARY This paper reports three cases of PC combined with lung adenocarcinoma diagnosed by video-assisted thoracic surgery lung biopsy, which were successfully managed by early diagnosis and treatment.
CONCLUSION The present case report might serve as a reminder not to neglect PC coexisting with adenocarcinoma. Early diagnosis and treatment lead to a better prognosis.
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Affiliation(s)
- Gui-Xian Zheng
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Hai-Juan Tang
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Zhi-Ping Huang
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Hui-Ling Pan
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Han-Yi Wei
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Jing Bai
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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Tashiro H, Haraguchi T, Takahashi K, Sadamatsu H, Tajiri R, Takamori A, Kimura S, Sueoka-Aragane N. Clinical impact of advanced chronic kidney disease in patients with non-HIV pulmonary cryptococcosis. BMC Pulm Med 2020; 20:116. [PMID: 32349734 PMCID: PMC7191728 DOI: 10.1186/s12890-020-1149-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/14/2020] [Indexed: 02/08/2023] Open
Abstract
Background Pulmonary cryptococcosis is an uncommon infectious disease that can develop in both immunocompromised and immunocompetent patients. The severity of chronic kidney disease (CKD) was reported to be one of the risk factors for pulmonary cryptococcosis, but its clinical characteristics have not been fully assessed. The purpose of this study was to clarify the clinical characteristics of advanced CKD in patients with pulmonary cryptococcosis. Methods The present study retrospectively investigated 56 patients who had non-human immunodeficiency virus (HIV) pulmonary cryptococcosis and were treated at Saga University Hospital between 2005 and 2018. The clinical characteristics were evaluated and compared between patients with estimated glomerular filtration rate (eGFR) > 45 mL/min/1.73 m2 (n = 42, early CKD) and those with eGFR < 45 mL/min/1.73 m2 (n = 14, advanced CKD. Results Compared with patients with early CKD, those with advanced CKD had significantly higher rate of disseminated cryptococcosis (21.4% vs. 2.4%, p = 0.03); lower percentage of patients who recovered after treatment (63.6% vs. 92.5%, p = 0.02); and more frequent clinical features of fever (57.1% vs. 19.0%, p < 0.01), pleural effusion (21.4% vs. 2.4%, p = 0.03), high white blood cell count (8550/mL vs. 6150/mL, p = 0.01) and C-reactive protein (CRP) (2.1 mg/dL vs. 0.2 mg/dL, p = 0.02), and low level of serum albumin (3.0 g/dL vs. 3.8 g/dL, p < 0.01). Multivariate analysis adjusted by immunosuppressive drug use indicated the significant factors of fever (odds ratio or β value [95% confidence interval] 6.4 [1.65–20.09], p < 0.01), high white blood cell count (1293.2 [110.2–2476.2], p = 0.03), C-reactive protein (0.89 [0.18–1.59], p = 0.01) and low level of serum albumin (− 0.34 [− 0.54 – − 0.14], p < 0.01) in patients with eGFR < 45 mL/min/1.73m2. Conclusion Advanced CKD was associated with poor clinical characteristics and outcomes in patients with non-HIV pulmonary cryptococcosis. Trial registration The patients in this study were registered retrospectively.
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Affiliation(s)
- Hiroki Tashiro
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture, 849-8501, Japan.
| | - Tetsuro Haraguchi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture, 849-8501, Japan
| | - Koichiro Takahashi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture, 849-8501, Japan
| | - Hironori Sadamatsu
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture, 849-8501, Japan
| | - Ryo Tajiri
- Clinical Research Center, Saga University Hospital, Saga, Japan
| | - Ayako Takamori
- Clinical Research Center, Saga University Hospital, Saga, Japan
| | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture, 849-8501, Japan
| | - Naoko Sueoka-Aragane
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture, 849-8501, Japan
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Wu HH, Chen YX, Fang SY. Pleural effusion in an immunocompetent host with cryptococcal pneumonia: A case report. World J Clin Cases 2020; 8:1295-1300. [PMID: 32337205 PMCID: PMC7176623 DOI: 10.12998/wjcc.v8.i7.1295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/06/2020] [Accepted: 03/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pulmonary cryptococcosis is an opportunistic infection that mainly occurs among immunocompromised patients although it can sometimes occur in immunocompetent individuals. However, the imaging findings of pulmonary cryptococcosis in immunocompetent hosts differ from those in immunosuppressed patients. In addition, the most common imaging findings of isolated pulmonary cryptococcosis are single or multiple nodules. Cavities and the halo sign are, however, prevalent in immunosuppressed patients. In immunocompetent patients, lung consolidation, pleural effusion or cavities are scarce.
CASE SUMMARY A 29-year-old Asian male was admitted to our hospital with complaints of cough and fever that had persisted for a month. As a chest computed tomography scan showed consolidation in his left lower lobe, he was initially diagnosed with pneumonia and received antibiotic treatment. A second review of the chest computed tomography image revealed multiple cavities and pleural effusion. Flexible fiberoptic bronchoscopy was subsequently performed, bronchoalveolar lavage fluid and serum cryptococcal antigen tests were positive. Cryptococcus capsules were observed in bronchoalveolar lavage fluid ink stain. Histopathological examination of a percutaneous lung biopsy from the left lower lobe further revealed granulomatous inflammation, and periodic acid-Schiff staining showed red-colored yeast walls, signifying pulmonary cryptococcosis. The patient was then treated with a daily dose of fluconazole (0.4 g), but the cough and fever still persisted. We therefore changed treatment to voriconazole (0.2 g, twice a day), and the patient’s clinical outcome was satisfactory.
CONCLUSION Although rare, clinicians should not disregard the possibility of cavities and pleural effusion occurring in immunocompetent hosts without underlying diseases.
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Affiliation(s)
- Huan-Huan Wu
- Department of Respiratory Medicine, Dongyang Hospital Affiliated to Wenzhou Medical University, Dongyang 322100, Zhejiang Province, China
| | - Yan-Xiao Chen
- Department of Evidence-base Medicine, Dongyang Hospital Affiliated to Wenzhou Medical University, Dongyang 322100, Zhejiang Province, China
| | - Shuang-Yan Fang
- Department of Respiratory Medicine, Dongyang Hospital Affiliated to Wenzhou Medical University, Dongyang 322100, Zhejiang Province, China
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Bastón Paz N, Hernández Betancor A, Esparza Morera R, Báez Acosta B, Santana Rodríguez É, Martín Sánchez AM. Pulmonary nodules: An unusual onset of HIV infection belatedly diagnosed. Rev Iberoam Micol 2019; 36:151-154. [PMID: 31537469 DOI: 10.1016/j.riam.2019.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 03/19/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Cryptococcosis is a generally systemic and potentially lethal fungal infection. Although HIV infection is a predisposing condition, especially if the CD4+ lymphocyte count is less than 100cells/mm3, other forms of immunosuppression may be associated with this opportunistic fungal condition, such as prolonged steroid therapy or solid organ transplantation. Pulmonary presentation must be included in the differential diagnosis of pneumonia or pulmonary neoplasia in the immunosuppressed patient. CASE REPORT We report a case of pulmonary cryptococcosis in a non-diagnosed HIV patient. In a 44 year-old male suffering from dyspnea and chest pain the image of a pulmonary nodule was observed in a radiological finding. In the histopathological study, intracellular structures suggestive of fungal conidia, and morphologically compatible with Cryptococcus, were observed. HIV serology and cryptococcal antigen detection in serum were requested, given the possibility of cryptococcosis. Cryptococcus neoformans var. grubii was isolated from the culture of the pulmonary biopsy. The patient was finally diagnosed with pulmonary cryptococcosis and HIV-1 infection. With a proper antifungal treatment the patient evolved satisfactorily. CONCLUSIONS The best strategy to avoid opportunistic infections such as cryptococcosis in HIV-infected patients consists of an early diagnosis and a highly active antiretroviral treatment. In our case, the diagnosis of a pulmonary infection by C. neoformans var. grubii allowed a late diagnosis of HIV-1 infection.
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Affiliation(s)
- Natalia Bastón Paz
- Servicio de Microbiología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Araceli Hernández Betancor
- Servicio de Microbiología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - Rafael Esparza Morera
- Servicio de Neumología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Beatriz Báez Acosta
- Servicio de Anatomía Patológica, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Évora Santana Rodríguez
- Servicio de Microbiología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain; Departamento de Ciencias Clínicas, Área de Microbiología, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Antonio Manuel Martín Sánchez
- Servicio de Microbiología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain; Departamento de Ciencias Clínicas, Área de Microbiología, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Zhang Y, Zhang SX, Trivedi J, Toll AD, Brahmer J, Hales R, Bonerigo S, Zeng M, Li H, Yung RC. Pleural fluid secondary to pulmonary cryptococcal infection: a case report and review of the literature. BMC Infect Dis 2019; 19:710. [PMID: 31405376 PMCID: PMC6691534 DOI: 10.1186/s12879-019-4343-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/31/2019] [Indexed: 12/16/2022] Open
Abstract
Background Pulmonary Cryptococcosis (PC) is diagnosed with increasing incidence in recent years, but it does not commonly involve the pleural space. Here, we report a HIV-negative case with advanced stage IIIB non-small cell lung cancer (NSCLC) treated with radiation therapy presented with dyspnea, a new PET-positive lung mass and bilateral pleural effusion suspecting progressive cancer. However, the patient has been diagnosed as pulmonary cryptococcal infection and successfully treated with oral fluconazole therapy. Case presentation A 77-year-old male with advanced stage non-small cell lung cancer treated with combined chemo-radiation therapy who presented with progressive dyspnea, a new PET-positive left lower lobe lung mass and bilateral pleural effusions. Initial diagnostic thoracentesis and bronchoscopy yielded no cancer, but instead found yeast forms consistent with cryptococcal organisms in the transbronchial biopsies of the left lower lobe lung mass. Subsequent to this, the previously collected pleural fluid culture showed growth of Cryptococcus neoformans. The same sample of pleural effusion was tested and was found to be positive for crytococcal antigen (CrAg) by a lateral flow assay (LFA). The patient has been treated with oral fluconazole therapy resulting in gradual resolution of the nodular infiltrates. Conclusion PC should be considered in immunosuppressed cancer patients. Additionally, concomitant pleural involvement in pulmonary cryptococcal infections may occur. The incidence of false positive 18FDG-PET scans in granulomatous infections and the use of CrAg testing in pleural fluid to aid in diagnosis are reviewed.
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Affiliation(s)
- Yuan Zhang
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, 5th Floor, Baltimore, MD, 21205, USA.,Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zheng Min Road, Shanghai, 200433, China
| | - Sean X Zhang
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Julie Trivedi
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Adam D Toll
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Julie Brahmer
- Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Russell Hales
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sarah Bonerigo
- Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Mingying Zeng
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, 5th Floor, Baltimore, MD, 21205, USA
| | - Huiping Li
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zheng Min Road, Shanghai, 200433, China.
| | - Rex C Yung
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, 5th Floor, Baltimore, MD, 21205, USA.
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Shastri PS, Kumar R, Gupta P. A Rare Case of Combined Pulmonary Cryptococcosis and Cryptococcal Meningitis in Renal Allograft Recipient. Indian J Crit Care Med 2019; 23:587-589. [PMID: 31988551 PMCID: PMC6970209 DOI: 10.5005/jp-journals-10071-23311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Invasive cryptococcosis is the third most common invasive fungal infection among organ transplant recipients.1 The most frequently encountered clinical manifestation is cryptococcal meningoencephalitis (CM) which may be easily missed because of varying clinical presentations. 1-year mortality is estimated at 20–30% even with long-term consolidated antifungal therapy. Here we report a case of combined pulmonary and cryptococcal meningitis in a renal allograft recipient. This case illustrates the difficulty of estimating the real extent of the disease when only clinical features are considered. The patient presented with nonspecific symptoms. Chest computed tomography (CT) scans revealed multiple pulmonary nodular shadows. The CT-guided biopsy of the pulmonary nodule clinched the diagnosis of pulmonary cryptococcosis (PC). The central nervous system (CNS) cryptococcosis was proved by positive culture and crypto-LA antigen in the cerebrospinal fluid (CSF).
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Affiliation(s)
- Prakash S Shastri
- Institute of Critical Care and Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Ravi Kumar
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Pallav Gupta
- Department of Pathology, Division of Histopathology, Sir Ganga Ram Hospital, New Delhi, India
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Li L, Zhuang L, Zhou J, Shao C. Pulmonary cryptococcosis coexisting with adenocarcinoma: a case report and review of the literature. J Med Case Rep 2018; 12:327. [PMID: 30384858 PMCID: PMC6214163 DOI: 10.1186/s13256-018-1853-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 09/19/2018] [Indexed: 02/06/2023] Open
Abstract
Background Pulmonary cryptococcosis is a common fungal infection frequently seen in immunocompromised patients. Owing to its nonspecific clinical and radiographic features, the differential diagnosis with secondary tuberculosis, malignant tumor, and bacterial pneumonia is sometimes difficult. Many case reports have focused on misdiagnosis of pulmonary cryptococcosis as a malignant tumor. But to the best of our knowledge, the coexistence of pulmonary cryptococcosis and malignant tumor is rarely presented. Case presentation A 52-year-old immunocompetent Han Chinese woman was presented to our emergency department complaining of headache and vomiting accompanied by postural changes. She was diagnosed with pulmonary cryptococcosis according to results of laboratory tests, computed tomography, and percutaneous lung biopsy. Owing to the poor therapeutic effects of 6-month fluconazole treatment, she underwent a second percutaneous lung biopsy and was diagnosed with pulmonary cryptococcosis coexisting with adenocarcinoma. Delayed treatment of malignant tumor resulted in lymph node metastasis, higher pathologic stage, and probably poorer prognosis. Conclusions Our patient’s case serves as a reminder not to misdiagnose pulmonary cryptococcosis coexisting with adenocarcinoma.
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Affiliation(s)
- Liyang Li
- Shanghai Respiratory Research Institute, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Liang Zhuang
- Cadre Ward, Sanming First Hospital, Sanming, 365000, Fujian Province, China
| | - Jian Zhou
- Shanghai Respiratory Research Institute, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Changzhou Shao
- Shanghai Respiratory Research Institute, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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Shuai SY, Xiong L, He XL, Yu F, Xia Q, Zhou Q. A unique case report of endobronchial cryptococcosis and review of the literature. Respir Med Case Rep 2018; 25:247-252. [PMID: 30302308 PMCID: PMC6174268 DOI: 10.1016/j.rmcr.2018.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 09/22/2018] [Accepted: 09/22/2018] [Indexed: 12/11/2022] Open
Abstract
Cryptococcosis is an infection caused by the yeast-like fungus Cryptococcus neoformans. Pulmonary cryptococcosis is typically identified as a single mass or as multiple nodules, while endobronchial lesions are quite rare. Here we report an uncommon case of pulmonary cryptococcosis presenting as endobronchial lesion in an immunocompetent patient. A 49-year-old male patient complained of intermittent cough with hemoptysis for two years. Computerized tomography of the chest showed a filling defect in the basal segment of the right lower lobe bronchus. A flexible bronchoscopic examination revealed a white smooth-surfaced polypoid lesion completely occluding the medial basal segment of the right lower lobe bronchus. The diagnosis was confirmed by bronchial biopsy under bronchoscopy, and the histopathologic findings showed the organisms were Cryptococcal neoformans. The patient was treated with fluconazole at a dose of 400 mg daily. The endobronchial lesion was found rapidly diminished after 18 days of therapy, and disappeared after 6.5 months of therapy by repeated fiberoptic bronchoscopy. Then the patient continued fluconazole for another 2.5 months. During the total 16 months' follow-up visits, the patient repeated CT scanning for five times, the results of which were all normal. The patient's symptoms disappeared as well, and now he is still under follow-up. This case highlights the fact that pulmonary cryptococcosis can present as endobronchial lesions even in immunocompetent subjects, mimicking lung tumor. Pathological confirmation is important to establish the definite diagnosis.
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Affiliation(s)
- Shi-Yuan Shuai
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Xiong
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin-Liang He
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fan Yu
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qin Xia
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiong Zhou
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Abstract
Objective Diagnosis of pulmonary cryptococcosis is difficult. In this study, we examined the clinical and radiological features that increase the diagnostic accuracy for pulmonary cryptococcosis. Methods This retrospective study included clinical data from 68 patients with pulmonary cryptococcosis from 2012 to 2016 in 3 tertiary hospitals. Results Among the 68 patients, 39 (57.35%) had no complications, 39 (57.35%) had clinical symptoms, 6 (8.82%) had a history of occupational exposure, 27 (39.71%) had a single nodule/mass (the most common type of pulmonary cryptococcosis) on chest computed tomography images, 21 (30.88%) had multiple nodules/masses, 16 (23.53%) had ground glass opacity with or without nodules, 2 (2.94%) had miliary nodules, and 2 (2.94%) had enlarged mediastinal lymph nodes. Fifty-three (77.94%) patients had lesions with irregular margins, 33 (48.53%) had spiculated lesions, 32 (47.06%) had air bronchograms, 9 (13.24%) had cavities, and 4 (5.88%) had calcifications. Twenty-four patients underwent surgery, 35 received antifungal treatment, and 9 received both treatments. Conclusion The clinical features and computed tomography signs found in this study are not specific for a diagnosis of pulmonary cryptococcosis. Therefore, an increased awareness of pulmonary cryptococcosis is needed among clinicians.
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Affiliation(s)
- Hui Deng
- 1 Department of Respiratory & Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jie Zhang
- 1 Department of Respiratory & Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jia Li
- 1 Department of Respiratory & Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Dongxu Wang
- 2 Department of Radiology, the Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, Heilongjiang, China
| | - Lei Pan
- 1 Department of Respiratory & Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xinying Xue
- 1 Department of Respiratory & Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Sawai T, Nakao T, Koga S, Ide S, Yoshioka S, Matsuo N, Mukae H. Miliary tuberculosis with co-existing pulmonary cryptococcosis in non-HIV patient without underlying diseases: a case report. BMC Pulm Med 2018; 18:6. [PMID: 29338706 PMCID: PMC5771133 DOI: 10.1186/s12890-018-0578-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 01/08/2018] [Indexed: 11/17/2022] Open
Abstract
Background Tuberculosis and cryptococcosis co-infection usually occurs in immunosuppressed patients with impaired cell-mediated immunity. However, there are few reports about such co-infection in non-HIV patients without underlying diseases. Here, we report a case of miliary tuberculosis with co-existing pulmonary cryptococcosis in non-HIV patient without underlying diseases. Case presentation An 84-year-old Asian female presented to our hospital with complaints of a 1-week history of abdominal pain and appetite loss. Chest computed tomography (CT) showed diffuse micronodules in random patterns in both lung fields. Liver, skin and bone marrow biopsies showed epithelioid cell granuloma. Polymerase chain reaction of gastric aspirate was positive for Mycobacterium tuberculosis. According to these findings, miliary tuberculosis was suspected and antimycobacterial therapy was initiated. After a 6-month treatment course, chest radiograph showed new multiple nodules in the right middle lung field. Chest CT showed that a right S6 small nodule was increased and new multiple nodules appeared in the right lower lobe. Flexible fiberoptic bronchoscopy was subsequently perfomed. Cytology of the bronchial lavage showed a small number of Periodic acid-Schiff-positive bodies, suggesting Cryptococcus species. Moreover, serum cryptococcal antigen testing was positive. According to these findings, pulmonary cryptococcosis was diagnosed, although the culture was negative. Oral fluconazole therapy was subsequently initiated. After a 6-month treatment course, chest radiograph showed gradual improvement. Conclusion Although tuberculosis and cryptococcosis co-infection is relatively rare in immunocompromised hosts, such as those with acquired immunodeficiency syndrome, clinicians should be aware that these infections can co-exist even in non-HIV patients without underlying diseases.
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Affiliation(s)
- Toyomitsu Sawai
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center, 6-39 Shinchi-machi, Nagasaki, 850-8555, Japan.
| | - Takumi Nakao
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center, 6-39 Shinchi-machi, Nagasaki, 850-8555, Japan
| | - Satoru Koga
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center, 6-39 Shinchi-machi, Nagasaki, 850-8555, Japan
| | - Shotaro Ide
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center, 6-39 Shinchi-machi, Nagasaki, 850-8555, Japan
| | - Sumako Yoshioka
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center, 6-39 Shinchi-machi, Nagasaki, 850-8555, Japan
| | - Nobuko Matsuo
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center, 6-39 Shinchi-machi, Nagasaki, 850-8555, Japan
| | - Hiroshi Mukae
- Second Department of Internal Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto-machi, Nagasaki, Japan
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He Q, Ding Y, Zhou W, Li H, Zhang M, Shi Y, Su X. Clinical features of pulmonary cryptococcosis among patients with different levels of peripheral blood CD4 + T lymphocyte counts. BMC Infect Dis 2017; 17:768. [PMID: 29237413 PMCID: PMC5729485 DOI: 10.1186/s12879-017-2865-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 11/28/2017] [Indexed: 11/17/2022] Open
Abstract
Background The clinical manifestation of pulmonary cryptococcosis varies notably between immunocompromised and immunocompetent patients. To better understand pulmonary cryptococcosis, we compared the clinical features of pulmonary cryptococcosis patients with or without decreased peripheral blood CD4+ T cell counts. Methods We retrospectively reviewed the medical records of 80 patients with cryptococcosis who had been treated in Jingling Hospital from January 2011 to January 2016. According to the normal range of peripheral blood CD4 + T-lymphocyte counts in our population, we chose CD4 = 378/μL as a cut-off value. Results The proportion of fever in the patients with decreased CD4+ T cells was higher than that of the patients with a normal amount of CD4+ T cells (86.7% vs 28.6%, P < 0.001). The incidence of clinical symptoms, such as cough (60.6% vs 64.7%, P = 0.729), chest pain (9.1% vs 26.5%, P = 0.064), and dyspnea (27.3% vs 23.5%, P = 0.725) showed no difference between patients with low CD4+ T cell counts and those with normal CD4+ T cell counts. The number of asymptomatic patients in the CD4+ T cell normal group was higher than that in the decreased CD4+ T cell group (17.1% vs 0%, P = 0.005). Nodules, masses, and halo signs were more common in the CD4+ T cell normal patients than in the low-CD4+ T cell patients (79.4% vs 54.5%, P = 0.03). The opposite trend was observed for cavitations (14.7% vs 51.5%, P = 0.001). The other CT findings, including pulmonary consolidation (P = 0.205), and pleural effusion (P = 0.641), did not differ significantly between the two groups. Conclusions CD4+ T lymphocytes have a significant impact on the clinical and radiological characteristics of pulmonary cryptococcosis. The patients with normal CD4+ T cell counts were found to have less fever and more nodule-like radiographic findings. Trial registration 2011NJKY-023-01. Registered on January 10, 2011.
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Affiliation(s)
- Qian He
- Department of Respiratory and Critical Care Medicine, Southern Medical University, Jinling Hospital, Nanjing, 210002, China
| | - Yuan Ding
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Wei Zhou
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Hongxing Li
- Department of Respiratory and Critical Care Medicine, Southern Medical University, Jinling Hospital, Nanjing, 210002, China
| | - Ming Zhang
- Department of Respiratory Medicine, Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yi Shi
- Department of Respiratory and Critical Care Medicine, Southern Medical University, Jinling Hospital, Nanjing, 210002, China
| | - Xin Su
- Department of Respiratory and Critical Care Medicine, Southern Medical University, Jinling Hospital, Nanjing, 210002, China. .,Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China.
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Zhang B, Cao W, Wu X, Wang S. Pulmonary cryptococcosis in immunocompetent patient: a case report. Int J Clin Exp Pathol 2017; 10:9798-9801. [PMID: 31966865 PMCID: PMC6965989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/16/2017] [Indexed: 06/10/2023]
Abstract
Pulmonary cryptococcosis (PC) is an opportunistic and conditional disease. It commonly occurs in immunocompromised patients. We presented a case of PC in an immunocompetent patient. This patient had the complaints of irritating cough and shortness of breath. A variety of antibiotic treatment was ineffective. The patient eventually received percutaneous transcutaneous biopsy and PC was diagnosed. Patient was treated by intravenous fluconazole for two weeks. The patient's follow-up was performed by Pulmonary Department, and we learned that the patient was well.
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Affiliation(s)
- Bin Zhang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Medical University Xi'an 710077, Shaanxi, PR China
| | - Wei Cao
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Medical University Xi'an 710077, Shaanxi, PR China
| | - Xiu Wu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Medical University Xi'an 710077, Shaanxi, PR China
| | - Shengyu Wang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Medical University Xi'an 710077, Shaanxi, PR China
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Kanjanapradit K, Kosjerina Z, Tanomkiat W, Keeratichananont W, Panthuwong S. Pulmonary Cryptococcosis Presenting With Lung Mass: Report of 7 Cases and Review of Literature. Clin Med Insights Pathol 2017; 10:1179555717722962. [PMID: 28814908 PMCID: PMC5546643 DOI: 10.1177/1179555717722962] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/30/2017] [Indexed: 12/15/2022] Open
Abstract
Pulmonary cryptococcosis is commonly found in immunocompromised patients. This microorganism rarely infects immunocompetent individuals, and when it does, it causes mild symptoms. The radiological findings of this disease may involve an intrapulmonary mass that mimics lung tumor. The objective of this study was to review the clinicopathological information, radiological findings, and treatment of patients who presented with intrapulmonary mass due to cryptococcosis. This study collected data from 7 patients who were treated at Songklanagarind Hospital, Songkhla, Thailand, between 2009 and 2014. Their clinical data, radiological findings, pathological results, and treatment protocols were reviewed. The patients were 2 women and 5 men, ranging in age from 37 to 79 years old. One case was an immunocompromised host. Four cases experienced the chest symptoms of dyspnea, hemoptysis, and chronic cough. The most common location of mass was the left lower lobe (71%). Four cases had a history of bird contact. Lung lobectomy was performed in 3 cases (42%), and all of the patients were treated with oral fluconazole. An intrapulmonary mass caused by this microorganism is mainly found in immunocompetent patients. Treatment with the antifungal drug fluconazole is very effective.
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Affiliation(s)
- Kanet Kanjanapradit
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Zdravko Kosjerina
- Department of Anatomical Pathology, Institute for Lung Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Wiwatana Tanomkiat
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Warangkana Keeratichananont
- Division of Respiratory and Respiratory Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Siripen Panthuwong
- Division of Infectious Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Hirano A, Yamasaki M, Saito N, Iwato K, Daido W, Funaishi K, Ishiyama S, Deguchi N, Taniwaki M, Ohashi N. Pulmonary cryptococcosis in a ruxolitinib-treated patient with primary myelofibrosis. Respir Med Case Rep 2017; 22:87-90. [PMID: 28721333 DOI: 10.1016/j.rmcr.2017.06.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/26/2017] [Accepted: 06/29/2017] [Indexed: 12/01/2022] Open
Abstract
We present the case of a 79-year-old man who showed multiple pulmonary nodules on chest computed tomography (CT) after being treated for 6 months with ruxolitinib, an inhibitor of Janus kinase (JAK) 1 and 2, to treat primary myelofibrosis. We examined the lesions by bronchoscopy, and the biopsy specimen revealed fungus bodies of Cryptococcus with granulomatous inflammation. As a result, the patient was diagnosed with pulmonary cryptococcosis. The patient was treated with fluconazole (200 mg daily for 2 weeks) with concomitant ruxolitinib administration, but the pulmonary lesions progressed. Subsequently, the patient was treated with voriconazole (300 mg daily for 3 weeks), but the lesions worsened further. The administration of ruxolitinib was therefore discontinued, and the dosage of voriconazole was increased to 400 mg daily. Three months later, the pulmonary lesions diminished in size. The present case of pulmonary cryptococcosis occurred in a patient treated with ruxolitinib. Treatment of pulmonary cryptococcosis with concomitant JAK inhibitor administration may result in poor treatment efficacy. It might be better to stop administration of JAK inhibitors, if possible, in patients being treated for pulmonary cryptococcosis.
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Wang RY, Chen YQ, Wu JQ, Wang X, Cao YH, Zhao HZ, Zhu LP. Cryptococcosis in patients with hematological diseases: a 14-year retrospective clinical analysis in a Chinese tertiary hospital. BMC Infect Dis 2017; 17:463. [PMID: 28673256 PMCID: PMC5496217 DOI: 10.1186/s12879-017-2561-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 06/22/2017] [Indexed: 11/10/2022] Open
Abstract
Background Cryptococcal infection has become a public health challenge globally. However, information about cryptococcal infection in patients with hematological diseases remains relatively rare. Methods HIV-uninfected cryptococcosis cases with hematological diseases admitted to Huashan Hospital from January 2001 to December 2014 were reviewed. Results In total, 33 cryptococcosis patients were enrolled, including 12 malignant and 21 non-malignant hematological cases. Twenty-six patients had central nervous system (CNS) involvement, which was observed more often in patients with non-malignancies than with malignancies (20/21 vs. 6/12, P = 0.001) Most patients (25/26) with CNS infection were confirmed by cerebrospinal fluid (CSF) culture or smear, and 100% (20/20) of them tested positive for the CSF cryptococcal antigen test. Eighteen out of 26 cryptococcal meningitis patients were treated with amphotericin B (AmB)-based therapy, 16 of them with AmB deoxycholate (d-AmB) and 2 patients with liposomal AmB. The clinical success rate was 55.6%. D-AmB was well-tolerated at 0.35–0.59 mg/kg/d (median 0.43 mg/kg/d) and only 12 patients had mild adverse events. Conclusions CNS cryptococcal infection was more frequent in patients with hematological non-malignancies, and cryptococcal antigen test as well as the CSF fungal culture or smear are suggested for early diagnosis. D-AmB could be used as an alternative therapy for CNS-infected patients with hematological diseases. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2561-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rui-Ying Wang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Central Urumqi Road, Shanghai, China
| | - Yan-Qiong Chen
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Central Urumqi Road, Shanghai, China
| | - Ji-Qin Wu
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Central Urumqi Road, Shanghai, China
| | - Xuan Wang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Central Urumqi Road, Shanghai, China
| | - Ya-Hui Cao
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Central Urumqi Road, Shanghai, China
| | - Hua-Zhen Zhao
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Central Urumqi Road, Shanghai, China
| | - Li-Ping Zhu
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Central Urumqi Road, Shanghai, China.
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Liu K, Ding H, Xu B, You R, Xing Z, Chen J, Lin Q, Qu J. Clinical analysis of non-AIDS patients pathologically diagnosed with pulmonary cryptococcosis. J Thorac Dis 2016; 8:2813-2821. [PMID: 27867557 DOI: 10.21037/jtd.2016.10.36] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Pulmonary cryptococcosis (PC) was not a rare infectious disease in non-AIDS patients. However, data on the immune status were lacking in southern China for comparative analysis of differences between immunocompromised and immunocompetent hosts. This study was to investigate the epidemiological, clinical, radiological, and treatment profiles for patients with PC. METHODS We performed a retrospective review of 88 patients diagnosed with tissue-confirmed PC who were not HIV-infected from 2003 to 2013. RESULTS Of 88 patients, 35(39.7%) were immunocompromised host. Fever and CNS symptom were significantly common in immunocompromised patients compared to immunocompetent patients (P=0.019 and P=0.036, respectively). The most frequent radiologic abnormalities were solitary or multiple pulmonary nodules, and masses or consolidations, and most lesions were located in the peripheral lung field. Cavitations and halo sign were significantly frequent in immunocompromised patients than in immunocompetent patients (P<0.05). The most frequently applied and reliable diagnostic procedure was CT-guided percutaneous translung biopsy. Treatment included antifungal drug alone in 20 patients, surgery alone in 20 including 3 treated by VATS, surgery plus antifungal drugs in 20 patients. CONCLUSIONS PC was not rare in immunocompetent host in southern China. Special differences remained in clinical manifestation and radiological findings of PC between immunocompromised and immunocompetent patients. Future work on the mechanisms of possible differences is required.
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Affiliation(s)
- Kaixiong Liu
- Department of Respiratory disease, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China;; Laboratory of Respiratory Disease of Fujian Medical University, Fuzhou 350005, China
| | - Haibo Ding
- Department of Respiratory disease, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China;; Laboratory of Respiratory Disease of Fujian Medical University, Fuzhou 350005, China
| | - Bing Xu
- Department of Neurology, Fujian Geriatric Hospital, Fuzhou 350003, China
| | - Ruixiong You
- Department of Radiology, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Zhen Xing
- Department of Radiology, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Jianfeng Chen
- Department of thoracic surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Qichang Lin
- Department of Respiratory disease, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China;; Laboratory of Respiratory Disease of Fujian Medical University, Fuzhou 350005, China
| | - Jieming Qu
- Department of Respiratory Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai 200040, China
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Chopra S, Capoor MR, Mallik R, Gupta S, Ray A, Khanna G, Suri JC, Bhattacharya D, Raghavan S. Pulmonary Cryptococcosis in HIV- sero-negative patients: case series from India. Mycoses 2015; 58:288-93. [PMID: 25817989 DOI: 10.1111/myc.12313] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 01/15/2015] [Accepted: 02/13/2015] [Indexed: 11/28/2022]
Abstract
Pulmonary cryptococcosis is likely to be misdiagnosed due to relatively non-specific clinical and radiological features. It is more frequently associated with immuno-suppressed conditions especially acquired immuno-deficiency syndrome (AIDS) and pulmonary tuberculosis (PTB). Four cases of pulmonary cryptococcosis were diagnosed over a period of eleven years. All patients in this case series were human immune-deficiency virus (HIV)-negative. The predisposing factors in these patients were diabetes mellitus (DM), acute lymphoblastic leukaemia (ALL), post-partum and pregnancy in one each of the patients. Relapse was seen in two cases. All the patients survived due to strict follow-up. Pulmonary cryptococcosis is common in non-AIDS patients and it warrants rapid diagnosis, treatment and follow-up to prevent relapse.
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Affiliation(s)
- Shimpi Chopra
- Department of Microbiology, V.M.M.C. and Safdarjang Hospital, New Delhi, India
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Xie X, Xu B, Yu C, Chen M, Yao D, Xu X, Cai X, Ding C, Wang L, Huang X. Clinical analysis of pulmonary cryptococcosis in non-HIV patients in south China. Int J Clin Exp Med 2015; 8:3114-3119. [PMID: 26064200 PMCID: PMC4443034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 02/03/2015] [Indexed: 06/04/2023]
Abstract
AIMS The aim of this study was to investigate the clinical characteristics of pulmonary cryptococcosis occurring in non-HIV patients, and to develop early diagnosis of pulmonary cryptococcosis in immunocompetent cases as well. METHODS We retrospectively reviewed the clinical data of 41 non-HIV infected patients with pulmonary cryptococcosis who were admitted to the First Affiliated Hospital of Wenzhou Medical University from January 2006 to April 2014. RESULTS The study included a total of 41 patients (23 males and 18 females) with mean age of 47 years. 12.19% of patients had a history of direct exposure to pigeon droppings; 31.70% of the patients' working or living environments were potentially contaminated by fungal spores. Almost one-third of the patients involved into the study were asymptomatic. The most common clinical manifestations were cough, expectoration and hemoptysis. The most common radiological manifestation was single node or mass in lung, which was described as untypical. Of all cases, 11 patients were diagnosed by CT-guided percutaneous cutting needle biopsy (PCNB), 5 patients were diagnosed by operation, and Crytococcus spore was found in 7 patients' cerebrospinal fluid. 8 patients' blood Cryptococcus Neoformans capsular polysaccharide antigens latex agglutination tests were positive. 36 patients received antifungal therapy. 5 patients underwent surgical resection. During 6 to 24 months follow-up, 40 cases showed total recovery and 1 cases showed improvement. CONCLUSIONS Pulmonary cryptococcosis in non-HIV subjects might be related to fungus-contaminated environmental exposure. The great variations and protean manifestations of its clinical features often lead to misdiagnosis. Recognition and invasive examination of non-HIV infected patients' pulmonary cryptococcosis in the early stage may help with improvement of its diagnosis and prognosis.
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Affiliation(s)
- Xiaona Xie
- Pulmonary Division, First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, China
| | - Botao Xu
- Division of General surgery, First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, China
| | - Chang Yu
- Division of Radiology, First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, China
| | - Mayun Chen
- Pulmonary Division, First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, China
| | - Dan Yao
- Pulmonary Division, First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, China
| | - Xiaomei Xu
- Pulmonary Division, First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, China
| | - Xueding Cai
- Pulmonary Division, First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, China
| | - Cheng Ding
- Pulmonary Division, First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, China
| | - Liangxing Wang
- Pulmonary Division, First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, China
| | - Xiaoying Huang
- Pulmonary Division, First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, China
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Kohno S, Kakeya H, Izumikawa K, Miyazaki T, Yamamoto Y, Yanagihara K, Mitsutake K, Miyazaki Y, Maesaki S, Yasuoka A, Tashiro T, Mine M, Uetani M, Ashizawa K. Clinical features of pulmonary cryptococcosis in non-HIV patients in Japan. J Infect Chemother 2014; 21:23-30. [PMID: 25444673 DOI: 10.1016/j.jiac.2014.08.025] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 08/03/2014] [Accepted: 08/21/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To clarify the clinical features of pulmonary cryptococcosis in Japanese non-HIV population. METHODS Retrospective investigation of 151 pulmonary cryptococcosis cases between 1977 and 2012 was executed. The underlying disease (UDs), aggravating factors, radiological characteristics, and treatment were examined. RESULTS Sixty-seven patients (44.4%) had no UDs. The common UDs were diabetes (32.1%) followed by hematologic disease (22.6%), and collagen disease (22.6%). Peripherally distributed pulmonary nodules/masses were most commonly seen. Lesions in the right middle lobe (p = 0.01) and air bronchogram (P = 0.05) were significantly more frequent, respectively, in patients with UDs than patients without them. Azoles were mainly selected for the patients without meningoencephalitis. Mean treatment duration for patients with and without UDs was 6.64 and 2.87 months, respectively. Patients whose pulmonary nodules improved after treatment continued to experience gradual reduction of cryptococcosis antigen titers, even if antigen titers were positive at the time of treatment cessation. The average time for antigen titers to become negative after treatment cessation was 13.1 and 10.7 months for patients with and without UDs, respectively. When groups were compared according to the presence of meningoencephalitis complications, deaths, and survivals, factors contributing to cryptococcosis prognosis included higher age, hypoproteinemia, hypoalbuminemia, steroid use, high C-reactive protein levels, and meningoencephalitis complications. CONCLUSIONS It is crucial to consider the presence of UDs and meningoencephalitis for the choice of antifungals and treatment duration for cryptococcosis in non-HIV patients. Three- and six months-administration of azoles for pulmonary cryptococcosis with or without UDs, respectively is reasonable.
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Affiliation(s)
- Shigeru Kohno
- Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Hiroshi Kakeya
- Department of Infection Control Science, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Koichi Izumikawa
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Taiga Miyazaki
- Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshihiro Yamamoto
- Department of Clinical Infectious Diseases, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kotaro Mitsutake
- Department of Infectious Diseases and Infection Control, Saitama International Medical Center, Saitama Medical University, Saitama, Japan
| | - Yoshitsugu Miyazaki
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Tokyo, Japan
| | - Shigefumi Maesaki
- Department of Infectious Disease and Infection Control, Saitama Medical University, Saitama, Japan
| | | | - Takayoshi Tashiro
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Mariko Mine
- Biostatistics Section, Division of Scientific Data Registry, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Masataka Uetani
- Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuto Ashizawa
- Department of Clinical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Abstract
Diagnosis of invasive fungal pneumonias by conventional culture methods is difficult to assess and often delayed. Nonmolecular fungal markers have emerged as an important adjunctive tool to support their diagnosis in combination with other clinical, radiologic, and microbiological criteria of invasive fungal diseases. Concerns about the sensitivity and specificity of some tests in different patient populations should lead to warnings about their widespread use. None can identify the emerging and particularly deadly fungal pathogens responsible for mucormycosis. The role of nonmolecular fungal markers should be better defined in combination with other microbiological and radiologic tools in preemptive antifungal strategies.
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Affiliation(s)
- Frédéric Lamoth
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Box 102359, Durham, NC 27710, USA; Clinical Microbiology Laboratory, Department of Pathology, Duke University Medical Center, 108 Carl building, Durham, NC 27710, USA; Infectious Diseases Service and Institute of Microbiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Barbara D Alexander
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Box 102359, Durham, NC 27710, USA; Clinical Microbiology Laboratory, Department of Pathology, Duke University Medical Center, 108 Carl building, Durham, NC 27710, USA.
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Pan JW, Zhang N, Jin YH, Ye ZT, Ma MQ, Cai XP, Cao Z. Pulmonary cryptococcosis presenting as wandering multiple bilateral shadows and hilar and mediastinal lymph node enlargement in the lungs. Trop Doct 2013; 43:144-7. [PMID: 24096908 DOI: 10.1177/0049475513502960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We present a case of pulmonary cryptococcosis presenting as wandering multiple bilateral shadows and hilar and mediastinal lymph node enlargement in which the fluconazole treatment suppressed the symptoms. This case illustrates the complex nature of immunological responses in the lungs and highlights the need to consider the existence of cryptococcal allergies.
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Affiliation(s)
- Jiong-Wei Pan
- Department of Respiratory, Lishui People's Hospital Zhejiang, No. 107 Liandu Jiguang Street, Lishui 323000, PR China.
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Yanagawa N, Sakai F, Takemura T, Ishikawa S, Takaki Y, Hishima T, Kamata N. Pulmonary cryptococcosis in rheumatoid arthritis (RA) patients: comparison of imaging characteristics among RA, acquired immunodeficiency syndrome, and immunocompetent patients. Eur J Radiol 2013; 82:2035-42. [PMID: 23954014 DOI: 10.1016/j.ejrad.2013.07.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 06/17/2013] [Accepted: 07/16/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE The imaging characteristics of cryptococcosis in rheumatoid arthritis (RA) patients were analyzed by comparing them with those of acquired immunodeficiency syndrome (AIDS) and immunocompetent patients, and the imaging findings were correlated with pathological findings. METHODS Two radiologists retrospectively compared the computed tomographic (CT) findings of 35 episodes of pulmonary cryptococcosis in 31 patients with 3 kinds of underlying states (10 RA, 12 AIDS, 13 immunocompetent), focusing on the nature, number, and distribution of lesions. The pathological findings of 18 patients (8 RA, 2 AIDS, 8 immunocompetent) were analyzed by two pathologists, and then correlated with imaging findings. RESULTS The frequencies of consolidation and ground glass attenuation (GGA) were significantly higher, and the frequency of peripheral distribution was significantly lower in the RA group than in the immunocompetent group. Peripheral distribution was less common and generalized distribution was more frequent in the RA group than in the AIDS group. The pathological findings of the AIDS and immunocompetent groups reflected their immune status: There was lack of a granuloma reaction in the AIDS group, and a complete granuloma reaction in the immunocompetent group, while the findings of the RA group varied, including a complete granuloma reaction, a loose granuloma reaction and a hyper-immune reaction. Cases with the last two pathologic findings were symptomatic and showed generalized or central distribution on CT. CONCLUSION Cryptococcosis in the RA group showed characteristic radiological and pathological findings compared with the other 2 groups.
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Affiliation(s)
- Noriyo Yanagawa
- Departments of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-8-22, Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan.
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